Tumour Thrombus in the IVC

Clinical History

A 60-year old man presented with pain in the right upper quadrant and in the epigastrium. Abdominal ultrasound was requested to examine the liver and biliary tree for a possible cause.

Case Description

Ultrasound revealed an occluded IVC containing thrombus-like material. The occlusion (tumour thrombus) extends a few millimetres into the proximal portion of one of the hepatic veins. Mild ascites in the RUQ and pleural effusion seen in the right lung. The gallbladder was empty with an oedematous wall appearance, which might have been secondary to the irritation caused by the ascites. An urgent CT pulmonary angiogram was recommended to further examine the occluded IVC and to assess the extent of the thrombus.

Diagnosis/ Discussion/ Treatment/ Follow up

An urgent CTPA revealed the IVC thrombus to be extending into the right atrium of the heart. A further CT contrast abdomen and pelvis suggested the thrombus might be a tumour as it was also seen to encase the right renal vessels and beyond the IVC. Overall, appearances were suggestive of either a thrombus due to hyperviscosity syndrome or a malignant tumour, possibly leiomyosarcoma.

Sonograms